What Happens During Angioplasty?

1/12/2015

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What Will You See in the Cath Lab? Angiogram tests and angioplasty procedures are performed in special hospital rooms called cardiac cath labs. In this video, Dr. John P. Reilly gives you a guided tour of the cath lab, pointing out the equipment you’ll see and explaining what it’s for. (Video provided courtesy of Dr. Reilly)

Angioplasty is performed in the cardiac catheterization laboratory, or “cardiac cath lab,” in a hospital. The physician who performs the procedure is called an interventional cardiologist, a heart doctor with additional education, training and experience in treating cardiovascular problems with thin, flexible tubes called catheters. Before the procedure, your interventional cardiologist will review any risks of the procedure and the anesthesia that will be used, as well as obtain your informed consent, which gives your physician permission to perform the procedure.

You will lie on a table and be mildly sedated to help you relax, but you will remain awake throughout the procedure. The process below describes angioplasty for coronary artery disease (CAD). Angioplasty for other conditions is similar, but you can learn more by reading about treatments for those specific conditions in their condition centers on this website and by asking your physician for details about the procedure.

Accessing the Artery

The interventional cardiologist will use a small needle to inject lidocaine (an anesthetic that makes you numb but doesn’t make you sleep) in the upper leg or in the arm. (This needle prick could be the only pain you will feel throughout the procedure.) The femoral artery in the upper leg – near where your leg bends from the hip – is one of the blood vessels doctors commonly use to insert the catheter and thread it through the arteries to the heart to perform angioplasty. Instead of the femoral artery, your doctor may choose to insert the catheter in the radial artery in the wrist.

From this access point in your leg or arm, a catheter is threaded through the arteries to your heart. (Since there are no nerves in your arteries, you will not feel the catheter.) An x-ray camera is used to project images of your arteries onto a television screen, and these images help the interventional cardiologist guide the catheter to the blockage in the artery.

When the catheter is properly positioned, the interventional cardiologist injects a contrast dye (also called radiographic contrast agent) through the catheter into the heart and its arteries. Most people do not feel the dye injection. However, some feel minor discomfort or a warm sensation, typically lasting only a few seconds, in their chest. A few feel lightheaded or nauseous.

Treating the Blockage in the Artery

If a blockage is found, a tiny, thin wire (called guidewire) is passed across the narrowed segment. It serves as a support for positioning the tiny balloon across the blockage. Next, a long, thin flexible tube (balloon catheter) with a small uninflated balloon at its tip is threaded through the guiding catheter, over the guidewire and into the artery to where the artery is blocked.

Once in position, the balloon is inflated. (The balloon may be inflated several times.) As the balloon inflates, it flattens the plaque against the wall of the artery. Some patients feel minor discomfort when it is inflated. If you have more than minor discomfort, medication can be given to relieve the pain. As the balloon inflates, plaque that extends into the wall of the artery may tear or crack. This is normal and necessary.

Once the balloon is deflated, x-ray pictures are taken to ensure the blockage is gone. When the balloon catheter is removed, final x-ray pictures are made.

After the Procedure

At the end of the procedure, the care team will work to close the puncture site where the catheter was inserted. For access sites in the upper leg, manual pressure is applied, sometimes in conjunction with a closure device (when the anatomy is suitable). Common examples of closure devices include a collagen plug or a stitch, each of which is designed to close up the hole in the blood vessel. Closure devices may increase patient comfort and decrease the time that the patient needs to remain on bed rest after the procedure, but in general, they have not been found to decrease the rate of bleeding.

If an artery in the arm was used to perform the procedure, the closure devices are slightly different from those used in the leg and generally consist of bands that go around the wrist, with either air or compounds that stop bleeding in the band.

Click here to see pictures of these devices and learn more about some of the tools interventional cardiologists when performing angioplasty and stenting to treat patients. You can also learn more about the different types of stents here to learn more about the different types of stents.

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